Provider Demographics
NPI:1336492818
Name:HAZELRIGG, SHANNON KENNEDY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:KENNEDY
Last Name:HAZELRIGG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 LUNDY TER
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4368
Mailing Address - Country:US
Mailing Address - Phone:703-975-0265
Mailing Address - Fax:
Practice Address - Street 1:1030 WILMER AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-2403
Practice Address - Country:US
Practice Address - Phone:877-814-3475
Practice Address - Fax:804-364-6585
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-20
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist